Tobacco quitlines provide tobacco cessation treatment at a remarkably modest cost, according to a study conducted at the University of Wisconsin School of Medicine and Public Health and reported in the American Journal of Preventive Medicine.

The article analyzes a survey, conducted by the North American Quitline Consortium, of the 38 quitlines in operation in 2004, to obtain baseline information about their organization, financing, promotion and cost.

The survey found that quitlines had a median per capita cost of 14 cents and a median cost per adult smoker of 85 cents. "When compared with the total economic cost of smoking of $3,931 per year, per smoker, estimated by the Centers for Disease Control, quitlines are really a bargain," says study author Paula Keller.

Quitlines have previously been shown to improve rates of quitting by 20 to 35 percent, and the more the potential quitter uses the quitline, the greater his chances for success. Because they are convenient (no transportation, available many hours during weekdays and weekends), confidential and free, individuals who smoke or chew tobacco are four times more likely to use a quitline than to seek face-to-face counseling.

Each week, a healthcare professional responds to a reader's
query on an industry issue. This week's expert is Roger Reed, executive vice president and chief health officer at Gordian Health Solutions.

Question: What percentage of participants who register for one of Gordian's 12-month programs actually complete the program? What about people dropping out once they're enrolled? How do you re-engage people?

Response: Our engagement model is currently an opt-in model, which means that we recruit and incentivize them to call us and enroll in our program. If they don't call us, we start our outbound telephonic outreach. When programs are offered on a voluntary basis, you'll only make contact with 50 percent of the people that you try to enroll. And you will only enroll about half of that 50 percent.

If the program is incentivized — typically a $20 to $30 per member per month incentive or premium differential — the enrollment rate rises dramatically to between 65 and 85 percent. Those individuals who know that their paycheck is going to be touched every month will enroll if they're eligible. Virtually nobody drops out. We have an incentive program whereby we "touch their paycheck:" change their premium contribution based on their compliance with the coaching effort that month. We turn this contribution off and on.

If participants are incentivized, they don't drop out. Close to 90 percent remain enrolled for the entire year because they don't want their paycheck touched. If participation is voluntary, half of them will have dropped out by the six-month point, and another 25 percent between the six- and 12-month point, so only about 25 percent will continue.

For more details on health coaches and behavior modification, as well as disease management for obesity, asthma, depression, maternity, Medicare and Medicaid, take a look at HIN's Disease Management Dimensions series, more than 500 pages of case studies, interviews and debates on the role of disease management in the healthcare industry:
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In this week's Disease Management podcast, discover the guiding principles for health coaching at Health Management Corporation (HMC) from Bonnie Sechrist, HMC's director of clinical program development. Ms. Sechrist also explains how these principles are translated into its health coach training program.

The link between oral cancer and heavy drinking makes dentists ideal sources of alcohol intervention, according to addiction experts at the Medical University of South Carolina (MUSC). Reported in the Journal of the American Dental Association, the study also found that most patients don't mind discussing alcohol use with their dentist.

MUSC researchers collected information from 408 adults. All were treated at an emergency walk-in dental clinic during a four-month period in 2005. Patients were asked questions about their drinking habits and their thoughts about having their dentist discuss alcohol use with them.

About 80 percent of people in the study said that dentists should feel free to ask patients about their drinking habits. About 25 percent said they would be embarrassed if their dentist asked such a question. However, 90 percent said they would give an honest answer.

The 25 percent of participants who were drinking alcohol at levels that could be considered harmful were just as open to talking with their dentist about their drinking habits as people who drank less or no alcohol.

More than 90 percent of the people in the study also agreed that if drinking were affecting their oral health, their dentist should advise them to reduce the amount they drink, or to quit. The National Institute on Alcohol Abuse and Alcoholism estimates that nearly 50 percent of cases of oropharyngeal cancer are associated with heavy drinking.

Is your organization targeting hospital re-admissions? What risk factors do you target? What strategies are you employing, and which are finding the greatest success? Complete our survey and you'll receive a free executive summary of the compiled results.

Lifestyle incentive programs — rewarding health-conscious behavior like stopping smoking and losing weight — are emerging resolutions to the modern dilemma of chronic care. In this new age of consumer-driven healthcare, improved self-awareness and information access encourage consumers to take charge of their own health. Employers are instituting lifestyle incentive programs to promote consumer accountability and cut excessive costs before getting out the checkbooks.

In a recent online survey conducted by the Healthcare Intelligence Network (HIN), employers and health plans discussed incentive program development within their companies. In considering specific incentives, rewards and initiatives, the survey analysis underscores an industry-wide effort to adapt to healthcare trends and simultaneously reward employees for healthy choices.

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